Vol 7, No 4 (2000)

Original study articles

The role of the clinician in the diagnosis of tumors of the musculoskeletal system

Makhson N.E., Makhson A.N.


Diagnosis of musculoskeletal tumors is quite often difficult and for the accurate diagnosis close collaboration of specialist in orthopaedic oncology, morphologist as well as roentgenologist is required. The more precise diagnosis of bone tumors can be made at specialized Centers (but not centers for general oncology) where roentgenologists and morphologists are trained for musculoskeletal tumors. Leading role in the collaboration of orthopaedic surgeon, roentgenologist and morphologist belongs to the clinician. These theses are confirmed by adduced clinical observations. The causes of diagnostic mistakes are analysed.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):3-7
pages 3-7 views

Treatment of comminuted fractures of the bones of the lower leg with rod and pincer apparatus

Gorodnichenko A.I., Uskov O.N.


From 1997 to 1999 thirty eight patients with splintered and polyfocal crus fractures (9 patients had open fractures) were treated by transosseous osteosynthesis using rod or pin-rod devices. Splintered diaphyseal fractures were of В and C groups according to AO/ASIF classification but peri- and intraarticular fractures were of A2,3 and C groups. In fractures with large intermediate fragments an universal reposition device with «floating» fixators of rods was applied. In cases of peri- and intraarticular fractures as well as in fractures with small intermediate fragments Gorodnichenko’s pin-rod device was used. The device provided stable fixation and patients with diaphyseal crus fractures were allowed full weight bearing from 3-5 postoperative day. The operative intervention is a low traumatic one that promotes early postoperative mobilization of patients, decreases the term of hospital treatment (mean 8.9 days). Fracture healing was achieved in all patients, no complications such as the imfiammation of soft tissues surrounding pins or rods were observed. The fixation was 12-18 weeks.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):8-12
pages 8-12 views

New in the surgical treatment of trochanteric fractures in elderly and senile patients

Kotelnikov G.P., Bezrukov A.E., Nudity A.G.


Compression device for osteosynthesis in trochanteric fractures is elaborated. Sufficient strength and stability of the femur fragments osteosynthesis in various types of trochanteric fractures was verified in the experiment on biodummies. Such level of strength and stability provides the possibility of early functional loading on the operated extremity. Surgical treatment using this device is indicated to elderly and senile patients without concomitant pathology as well as to patients with compensated changes in inner organs and systems after adequate preoperative management. The elaborated technique was applied in 37 patients. Results for the period up to 1 year were evaluated in 30 patients. Surgical treatment using new compression device is shown to allow decrease the rate of insufficient results to 3.3% as compared to 31% in conservative treatment.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):13-17
pages 13-17 views

The method of surgical treatment of ars-syndrome

Mironov S.P., Orletsky A.K., Vasiliev D.O.


The original surgical technique for the treatment of ARS-syndrome in athletes is suggested. This technique consists of myofasciotomy and fascioplasty of m. rectus abdominus as well as partial myotomy of adductor muscles of the hip. Six patients have been operated on using this method. At 1 year follow-up the results are evaluated as good.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):18-19
pages 18-19 views

About steroid therapy for Achilles tendon pathology

Demichev N.P., Khairulin Y.K., Filimonov E.P.


The experience in treatment of 3 patients with rupture of Achilles tendon due to steroid injections in connected with achillodynia or tendoperiosteopathy of calcaneal tuber is presented. There 3.5% of patients with such pathology out of all patients with Achilles tendon rupture. In those patients the tendon rupture was shown to be caused by insignificant physical load (quick walking, slight jump). Postoperatively all patients had complications in form of diastasis of cutaneous wound margins. In one patient necrosis of wound with tendon involvement was noted. 3.5 months after operation the wounds healed by granulation. The severity of postoperative course was noted to be directly proportional to the number of corticosteroid injections into Achilles tendon.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):20-22
pages 20-22 views

The use of surface-demineralized implants in the treatment of post-traumatic false joints in children

Merkulov V.N., Lekishvili M.V., Dorokhin A.I.


At the Pediatric Trauma Department (CITO) in 6 patients with post-traumatic pseudoarthroses of different localization new bone implants elaborated at «СІТО Bone Bank» were used. This new bone implant was a surface-demineralized liophylized graft sterilized by the stream of quick electrons in 20 KGy dose. Bone implants were applied in complex with metal osteosynthesis, mainly transosseous one. Positive results were achieved in all cases. The term of regeneration, absence of immunologic reactions testified the efficacy of treatment tactics and high plastic properties of the grafts. Analysis of experience of treatment of children with post-traumatic pseudoarthrosis allows to conclude that application of demineralized liophylized implants is perspective.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):22-25
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Our experience in the treatment of congenital hip dislocation in children of different ages

Malakhov O.A., Kozhevnikov O.V., Gribov I.V., Kralina S.E.


The experience in treatment of children with neglected congenital hip dislocation is presented. The main principles of management are defined. The successive complex of curative measures including conservative treatment using Ter-Egiazarov-Sheptun functional plaster bandage in children over 6 months is described in detail. In failed conservative treatment the reduction of dislocation is performed using over head technique. In children over 3 years descent of femoral head and reduction of dislocation are carried out on distraction system followed by surgical correction of all dysplastic elements of the hip joint. Technique of detorsion-varus osteotomy with application of distraction system and closed reduction is described. Long-term results were evaluated using CITO score system in 255 patients. Good and satisfactory results were in 91.7% of cases.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):26-31
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Method of radioulnar superposition in the treatment of patients with congenital radial club hand

Prokopovich V.S.


New technique for the treatment of congenital club foot in patients with great malformation of the radius in the distal forearm is presented. Surgical intervention consists of 2 stages. First the distraction device is applied to correct the radius deviation and simultaneously to descent the hand distally together with hypoplastic radius. On the second stage the distraction device is taken off, partial resection of the distal ulnar epiphysis and resection of the proximal end of the hypoplastic radius is performed with following reposition of the ends. This method radioulnar superposition enables to eliminate the club hand, to preserve the wrist joint and to restore its physiologic functions.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):32-34
pages 32-34 views

Total hip arthroplasty with own design endoprosthesis

Rutsky A.V.


The basis of hip joint implant elaboration is the principle of primary stable fixation of its components. This is achieved owing to the peculiarities of the implants design, its shape, proportions, surface structure. The stem of the implant is wedge-shaped in three dimensions («triwedge»). The cup has a shape of truncated cone with a spherical segment as an apex. In the proximal stem and spherical segment of the polymeric cup there are porous inserts with pores of 150-350 mkm. This provides the bone ingrowth into implant without disturbance of its nutrition as proved out by the experimental data. The implant is made of high-quality materials by modern production process. Since 1999 more than 600 operations using new implant were performed in Belarus. 173 patients were operated on at the Trauma and Orthopaedic Clinic of the Belarus Institute for Advanced Medical Studies during 1997-1999. Preliminary results are favorable.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):34-38
pages 34-38 views

Do phospholipids affect the friction of articular cartilage on silicone rubber? (experimental study)

Gavryushenko N.S., Bulgakov V.G., Shalnev A.N., Anikin A.V.


The results of model experiments showed that when surfaces of native articular cartilages interacted friction coefficient was within 0.02-0.07 (depending on the load quantity). When cartilagenous surfaces interacted with silicone rubber that index was 3 to 6 times higher. Putting of 3-6 mg/cm2 of egg or synthetic polymerized phosphatidylcholone on the surface of silicone rubber considerably decreased the friction coefficient at interaction of rubber with the cartilagenous surface while the administration of the same quantity of egg phosphatidylcholine in the form of 10% aqueous suspension into the friction zone gave no effect. The data obtained indicate that the of phospholipids for the improvement of tribological characteristics of joint implants is a prospective one.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):39-42
pages 39-42 views

Results of Spectral Determination of Metals in Tissues Adjacent to the Sivash System Hip Endoprosthesis (Experimental Clinical Study)

Sherepo K.M., Makarenko T.F.


After total hip replacement with Sivash’s implants marked metallosis by chromium, cobalt and to a lesser degree by molybdenum develops in tissues contiguous with the joint. Titanium and tin are also determined in considerable amounts. At experimental (2 months to 5 years) and clinical (3 weeks to 15-19 years) follow up all metals are determined in the connective tissue. In bone tissue only small amounts of metals were present even in long term follow up. In short terms metallosis develops in the zones close to the mobility unit and gradually distributes along the bone marrow canal. As shown by experimental data metallosis is detected only as traces when the implant without friction units is used. In stable and unstable implants the degree of metallosis was the same although its incidence was higher when loosing developed. Our data confirm the possibility of the total hip prosthesis loosing but it develops gradually and manifest clinically in late terms.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):43-47
pages 43-47 views

Our experience with plantar fibromatosis (Ledderhose's disease)

Meltzer R.I., Oshukova S.M., Milkin V.M.


Authors observed 4 patients with relatively rare pathology, i.e. Ledderhose disease. Only one out of 4 patients visited a clinician when the nodes started to form in plantar aponeurosis. The others consulted with the doctor when disease was at the stage of toe desmogenic contractures formation. As this pathology is often combined with palmar fibromatosis for its early diagnosis it is recommended to examine the feet in patients with Dupuytren’s contracture. Perfected surgical technique for the treatment of Ledderhose disease is suggested. This technique takes into account a multicomponent pattern of flexion-adduction contracture of the great toe.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):48-49
pages 48-49 views

Terminology in vertebrology (historical and epistemological aspects)

Nazarenko G.I., Cherkashov A.M.


According to the literature data reliably increasing rate of pathologic processes and diseases manifestating by back pain is noted. Because such conditions are treated by physicians of different specialities there is not unity in the definition of these pathologic processes. The attempt to analyze historic and gnosiologic origin of vertebrologic terminology is undertaken. It is shown that such diagnosis as «osteochondrosis» possesses no constructive information and this causes the difficulty in management of patients. Authors suggest that the diagnosis must reflect the pattern and location of the pathologic process that ill help the physician to perform specific diagnostic and therapeutic programs. Classification which characterises the spine pathology in detail is given.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):50-56
pages 50-56 views


Modern aspects of the treatment of post-traumatic deforming arthrosis of the ankle joint

Arkhipov S.V., Lychagin A.V.


Post-traumatic deforming arthrosis of the ankle joint is a severe complication of damage to articular structures. The severity of its clinical manifestations depends on a number of factors: the time elapsed since the injury, the severity of primary anatomical disorders, the activity of reparative processes, the presence of tibiofibular diastasis, the state of the ligamentous apparatus, paraarticular tissues, and neurotrophic disorders.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):64-67
pages 64-67 views

Pathogenetic features of the infectious process in traumatology and orthopedics

Kuzmin I.I.


Infections of the osteoarticular system are among the most difficult to diagnose and treat, due to a number of factors:

  1. morphological and functional characteristics of the bone matrix [29];
  2. frequent use of various abiogenic materials (metal structures, endoprostheses, bone grafts, cements [21,22], etc.);
  3. polymicrobial nature of the colonizing microflora;
  4. latent clinical course, which leads to delayed diagnosis.
N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):67-71
pages 67-71 views


Tendopathy of the elbow joint

Mironov S.P., Burmakova G.M.


Tendopathy at the point of attachment of the tendons to the bone (insertional tendinopathy) is a consequence of typical overload injuries and is observed mainly in athletes. It is known that the same load can lead to both positive adaptation with tendon hypertrophy and its subsequent strengthening, and dystrophic changes in the area of attachment with a decrease in tendon strength.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):57-63
pages 57-63 views


Veniamin Mikhailovich Lirtsman


Honored Doctor of the Russian Federation, Doctor of Medical Sciences, Professor V.M. Lirtsman. It is difficult to believe in this: sharpness of mind, instant reaction, ability for accurate analysis, sparkling humor (and sometimes sarcasm) - all these qualities have only increased in him. And the wisdom that comes with age seems to have been born with him. So, maybe the classic was right and “all the calendars lie”?

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):78-78
pages 78-78 views


Nikolay Ivanovich Pirogov on the occasion of the 190th anniversary of his birth


Nikolai Ivanovich Pirogov, an outstanding surgeon, world-famous scientist, founder and classic of military field surgery, was born on November 13 (25), 1810 in Moscow in the family of Ivan Ivanovich Pirogov, treasurer of the Moscow food depot. At the age of 14, on the recommendation of the Dean of the Faculty of Medicine of Moscow University, one of the founders of Russian traumatology, Professor E.O. Mukhin was admitted to the medical faculty of the university. At the age of 17, he graduated from the university course as a doctor of the 1st department. Patron NI. Pirogova E.O. Mukhin recommended him as the most capable student as a candidate for the students of the "Professor's Institute" of the University of Dorpat. Having passed the entrance exam at the Academy of Sciences in St. Petersburg, Nikolai Ivanovich in 1828 went to work at the University of Dorpat. From the first days, in addition to working in the clinic, he devotes a lot of time to anatomy and animal experiments. A year later, he was awarded a gold medal for a competitive work on the topic “What is observed when large arteries are ligated during surgery?”.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):72-74
pages 72-74 views

A word about a teacher


On August 28, in the 97th year, Arkady Vladimirovich Kaplan, an outstanding traumatologist-orthopedist, who was and remains a Teacher, not only for us “Zit” members, but also for all the specialists of our once vast country, passed away. The teacher lived a long life and, together with the whole country, experienced the severity of the totalitarian regime, and the hardships of everyday life, and the bitterness of defeat in the first years of the most cruel and destructive war of the expiring century, and the immeasurable joy of the great Victory over fascism.

N.N. Priorov Journal of Traumatology and Orthopedics. 2000;7(4):75-77
pages 75-77 views

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